Loading...
Monroe, Frederick Hayes NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frederick Hayes Monroe Male Date of Death Age If Veteran of U.S.Armed Forces, 12/17/2021 76 Years War or Dates 1966-1972 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident 0 Homicide Suicide ❑Undetermined Ej Pending O Circumstances Investigation W Medical Certifier Name Title O Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 609 ElBurial Date Cemetery,Crematory or Facility Name 12/27/2021 Pine View Crematorium EIEntombment Address 0 Cremation Queensbury Hamlet,New York ElDonation ZO ❑Removal Date Place Removed and/or and/or Held t- t� Hold Address 0 O. Date Point of ❑U0 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above g Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2021 Registrar of Vital Statistics 4ig6ertAndrew Curtis(ECectronicaQy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition A2-.7 7-.202/ Place of Disposition ?; n/C' 1f;G4LIJ (address) uJ (section) (lot num r) (grave number) Name of Sexton or Person in Cha of Premis ►i fr p v c i tJ (please print) LU Signature 1 1j Title () J-1" DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20T'' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#,!